Abstract
Background
Placement of a self-expanding metal stent (SEMS) in patients presenting with colorectal cancer as an acute large bowel obstruction may obviate emergency surgery, potentially effectively palliating incurable cancers and acting as a bridge to surgery in patients with operable tumours. We present our experience with stenting for malignant acute large bowel obstruction over a 6-year period (2006–2011).
Methods
A prospectively compiled colorectal cancer database was reviewed to identify all patients presenting to our unit with malignant acute large bowel obstruction who had stenting carried out to achieve colonic decompression. All 44 procedures were performed by colorectal surgeons using a combined endoscopic and fluoroscopic technique.
Results
Overall, successful decompression was achieved in 42 patients by SEMS insertion (95.5 %). Technical and clinical success was achieved in all 30 patients undergoing stenting as a palliative measure (100 %). There was no clinical perforation in any of the 44 patients.
Conclusions
SEMSs insertion is a safe and effective technique for colonic decompression in the setting of acute malignant large bowel obstruction as either a palliative measure or as a bridge to subsequent resection.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Iversen LH, Bülow S, Christensen IJ, Laurberg S, Harling H, Danish Colorectal Cancer Group (2008) Postoperative medical complications are the main cause of early death after emergency surgery for colonic cancer. Br J Surg 95:1012–1019
Cuffy M, Abir F, Audisio RA, Longo WE (2004) Colorectal cancer presenting as surgical emergencies. Surg Oncol 13:149–157
McArdle CS, Hole DJ (2004) Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg 91:605–609
Iversen LH, Kratmann M, Bøje M, Laurberg S (2011) Self-expanding metallic stents as bridge to surgery in obstructing colorectal cancer. Br J Surg 98:275–281
Dohmoto M (1991) New method-endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig 3:1507–1512
Bonin EA, Baron TH (2010) Update on the indications and use of colonic stents. Curr Gastroenterol Rep 12:374–382
Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99:2051–2057
Young CJ, Suen MK, Young J, Solomon MJ (2011) Stenting large bowel obstruction avoids a stoma: consecutive series of 100 patients. Colorectal Dis 13:1138–1141
Foo C, Poon JT, Law WL (2011) Self-expanding metallic stents for acute left-sided large bowel obstruction: a review of 130 patients. Colorectal Dis 13:549–554
Sagar J (2011) Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev 9:CD007378
van Hooft JE, Fockens P, Marinelli AW, Bossuyt PM, Bemelman WA (2006) Premature closure of the Dutch Stent-in I study. Lancet 368:1573–1574
van Hooft JE, Fockens P, Marinelli AW, Dutch Colorectal Stent Group et al (2008) Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy 40:184–191
Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballon P, Moreno-Azcoita M (2002) Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 45:401–406
Saida Y, Sumiyama Y, Nagao J, Uramatsu M (2003) Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 46:S44–S49
Ng KC, Law WL, Lee YM, Choi HK, Seto CL, Ho JW (2006) Self-expanding metallic stent as a bridge to surgery versus emergency resection for obstructing left-sided colorectal cancer: a case-matched study. J Gastrointest Surg 10:798–803
Tilney HS, Lovegrove RE, Purkayastha S et al (2007) Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 21:225–233
Zhang Y, Shi J, Shi B, Song CY, Xie WF, Chen YX (2012) Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis. Surg Endosc 26:110–119
Cheung HY, Chung CC, Tsang WW, Wong JC, Yau KK, Li MK (2009) Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg 144:1127–1132
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Larkin, J.O., Moriarity, A.R., Cooke, F. et al. Self-expanding metal stent insertion by colorectal surgeons in the management of obstructing colorectal cancers: a 6-year experience. Tech Coloproctol 18, 453–458 (2014). https://doi.org/10.1007/s10151-013-1073-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-013-1073-0